Singing and gargling

Hutan

Hutan

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Staff member
At the ANZMES (Association of NZ ME Societies) annual general meeting yesterday, Dr Ros Vallings gave a research update. Dr Vallings is NZ's only physician focused on ME. She talked positively about the presentation of Dr Markku Partinen at this year's
Invest in ME C13 conference. I'll cover Dr Vallings' other takeaways from Dr Partinen's presentation elsewhere, but here I want to talk about singing and gargling treatments.

The Invest in ME summary of Dr Partinen's talk included the following question and answer:
Question: You mentioned vagal stimulation. There are suggestions such as gargling or singing very loudly can help vagal stimulation. The person asking the question found singing loudly improved their sleep.

Answer: That is possible and vagal stimulation is now used in intractable epilepsy and they may even put electrodes inside the brain but there are now some external stimulators as well. Studies should be done to test this properly.
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I'm not sure if Dr Vallings has built her treatment recommendation on Dr Partinen's seemingly very lukewarm endorsement of these activities as useful for vagal stimulation (e.g. 'That is possible') or if she only used that as a start point and has done further research.

Regardless, Dr Vallings advised that people with ME should sing in the shower or, if we prefer, gargle. My memory of this advice was that the idea that this would result in improved sleep, specifically deep sleep, was presented with quite a lot of certainty. (Ros said that Dr Partinen was suggesting that people with ME do not get enough deep sleep.) I believe that there may be a video of her presentation in due course, so we will be able to check what exactly was said.

Now, singing in the shower and gargling seem like fairly harmless activities, and singing at least might even be quite pleasant. But certainly on first hearing, the idea that singing and gargling would be helpful for any ME symptoms via a vagal nerve stimulation mechanism sounded odd to me.

I have since googled 'vagal nerve stimulation singing and gargling' and I am amazed at the amount of information about this and the even greater amount of literature about vagal nerve stimulation for a great many bodily complaints. I didn't find anything that I found particularly credible to support the idea that singing in the shower and/or gargling improve ME or sleep or the sleep of people with ME.

What do you reckon? Have any of you tried a concerted program of either gargling or shower singing? Presumably even singing outside of the shower might count.

So, is there evidence that:
1. the vagus nerves of people with ME are understimulated?
2. that we are not getting enough deep sleep?
3. that singing and gargling do actually stimulate the vagus nerve? (I think there might be some evidence for this.)
4. that stimulating the vagus nerve results in deep sleep?

Is Dr Vallings alone in promoting shower singing and gargling as ME treatments operating via a vagus nerve stimulation mechanism or do other ME specialists support this?

Any corrections to any of the foregoing will be appreciated.
 
I don’t know the answers to your questions, but one thing I do know is that singing exhausts me. I can’t do it much anymore.
My instinctive reaction is that this sounds like nonsense....:(

The vocal folds use the recurrent laryngeal nerves which are branches of the vagus - so yes, anything that uses voice will be using the vagus nerve. Why singing should be any better for vagus nerve stimulation than speaking or shouting or even coughing...???

A quick search via google brings up lots of alternative sites promoting this but nothing mainstream science is there at least on the first page. So I’m suspicious.
 
If I remember my undergraduate anatomy correctly the vagus nerve connects to the external ear canal and to the stomach, so perhaps sticking our fingers in our ears and wiggling them about or even eating a large meal could be seen as stimulating the vagus.

Even if singing in the shower does aid deep sleep, there are so many potential explanations of this over and above any vagal stimulation. The vagus, as indicated by its name, wanders all over the place and why should one form of stimulation over and above any other have such importance?

It is not surprising that there is interest in the vagus in relation to ME, given its wanderings take in many of the otherwise diverse systems involved in our condition, however we at present have little understanding why or how that might related to such as the genetic/paragenetic issues or mitochondrial dysfunction and to our condition overall.

Is there any evidence that any form of nerve stimulation has clinical effects, let alone something as confusing as vagal nerve stimulation?
 
This feels a bit like this should be an April the first joke. I’m finding all the vagus nerve stuff similar to microbiome and off causation theories about cytokines.....you seem to have to wade through a lot of poor science to get to anything that can be discussed sensibly with even a smattering of evidence.

They all seem to leap from correlation to causation without very much in-between. The premise of the nervous system as a thing that needs stimulation (whatever that means) seems to be at the heart of the nonsense. Whenever I hear about people trying to stimulate nerves I think of weird physios that have a sideline in tealeaf reading or chanting around a crystal. The loose reference to sleep and epilepsy is a warning sign for me that it should be viewed as mostly quackery.

I personally take most sleep studies with a large pinch of salt since in a lot of cases these are poor studies run by psychiatrists or behavioural ‘scientists’ that are highly dubious (similar to bps study failings)...mostly loose correlation and conjecture. And as for epilepsy treatment, it’s interesting that non experts in this think that by mentioning a condition that is quite common and well known that this somehow endorses the other theory. The reality is that for over half of the cases of epilepsy, the cause is still unknown and the treatments in a lot of cases are crude or inadequate...mostly because of poor science (neurologists mixed with psychiatrists) and stigma.

-probably codswallop.
 
I have no answers either I'm afraid.

Singing, much as I love it, exhausts me. It is classed as torture by those within earshot. So no.

Singing while in the shower - just getting in the shower and managing a wash is an achievement for many. Trying to remember to do something else as well is ridiculous. Bearing in mind I'll still have to dry off and put some clothing on when I'm done.

Gargling. Nope. When I was a kid I had to gargle with salty water if I had a sore throat. Needless to say I did this a lot when I first became ill and I had major sleep problems at the time. No gargling in the world is going to make a difference when pain stops you falling asleep and wakes you up.

At times I sleep very well - mainly when I'm anaemic, admittedly. The better I sleep, the worse I feel. So, for me, the hypothesis still needs a lot of work.

Without solid research behind it, the notion that singing or gargling will make a significant difference trivializes the disease to my mind. You can imagine a doc somewhere, who knows little to nothing about ME, hearing about this and thinking the illness can't be so bad then. Cue the usual disbelief and attitude when the patient tries to explain the severity of symptoms and the extent of their disability.
 
Anyone thinking that singing loudly is something ME patients should do does not understand much about this disease. Except maybe with earplugs and noise blockers, but certainly not in the shower, which amplifies sound.

Any noise above quiet talking hurts and singing takes way too much energy.
 
Sly Saint said:
Also, don't people generally (ie not pwME) sing in the shower in the morning (ie when the want to wake up), not at night when they want to go to sleep!
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That 's true. I have to time my showers carefully. Can't do morning showers. Can't do showers too close to bedtime as the activity, though exhausting, wakes me up.
 
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Invisible Woman said:
Without solid research behind it, the notion that singing or gargling will make a significant difference trivializes the disease to my mind.
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My first reaction is to laugh at this singing/gargling idea. But my second reaction is to wonder how we justify trying to get funding for research if singing in the shower solves our problems?

I find the over-emphasis on things like sleep hygiene in many lists of treatments annoying too. I generally have no trouble falling asleep and staying asleep unless I'm in pain and, unless I'm in PEM when I sleep longer, I wake at 6 am every morning. The frequent advice about not using screens for two hours before bed time makes it sound, to people not familiar with the illness, as though a few minor lifestyle changes will make a material difference.

Sly Saint said:
Also, don't people generally (ie not pwME) sing in the shower in the morning (ie when the want to wake up), not at night when they want to go to sleep!
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Despite my comment about the two young women in the video above not looking sleepy after singing and gargling, I understand that the supposed method of action might not be immediate, but some sort of gradual building up of the 'tone of the vagus nerve'. But that then just adds another step in the whole chain of reasoning that has to work in order for this treatment to be effective.
 
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Hutan said:
I find the over-emphasis on things like sleep hygiene in many lists of treatments annoying too.
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Me too.

For all the wittering on about sleep hygiene and advice normally dished out to pwME I haven't seen any evidence that we all share the same sleep issues. Some patients sleep, but it's unrefreshing; others have difficulty falling and staying asleep and so on.

At different times my sleep issues have differed - sometimes hypersomnia, other insomnia, but nearly always unrefreshing. I do have comorbidities such as Hashimoto's and anaemia though.
 
Hutan said:
Is Dr Vallings alone in promoting shower singing and gargling as ME treatments operating via a vagus nerve stimulation mechanism or do other ME specialists support this?
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Aren't there some theories that in ME (or was it POTS?) the sympathetic-parasympathetic nervous system balance is skewed toward the sympathetic? And that stimulating the vagus nerve stimulates the parasympathetic side and so may help to re-balance? Or not. I don't recall any hard science on any of this but I may just have forgotten.
Hutan said:
Have any of you tried a concerted program of either gargling or shower singing?
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For what it's worth, I've been gargling diligently for years for gum and throat issues. Has no effect on sleep. I also do frequent breathing exercises for relaxation that also happen to stimulate the vagus nerve, at least so they say. Works for relaxation, no effect on sleep though. Singing is out of the question for me, too exhausting.

When I say no effect on sleep I mean no effect on my PEM insomnia, unfortunately nothing touches that, not even strong sleeping pills.At base line I mostly sleep not exactly well, but ok-ish. I practice perfect sleep hygiene plus the breathing exercises and the gargling. It's conceivable that at base line I'd sleep less well without the gargling and breathing exercises, impossible to tell but I'm skeptical.But for me the PEM sleep problems either have nothing to do with the vagus nerve at all, or else the little bit of vagus stimulation you can get from vibrating your vocal cords is just nowhere near enough to make a difference.
Invisible Woman said:
Without solid research behind it, the notion that singing or gargling will make a significant difference trivializes the disease to my mind.
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Couldn't agree more.
 
Another reason I would like to know the source of Ros Vallings information on this because if it's from her own patients simply reporting back to her that raises a red flag for me.

Where ME docs are few and far between, if you find a doctor willing to help you with symptomatic relief using pain or sleep meds, then the chances are you'll just agree and nod politely with a more daft idea. You certainly won't rock the boat by telling them it's complete bunkum.
 
Invisible Woman said:
Another reason I would like to know the source of Ros Vallings information on this because if it's from her own patients simply reporting back to her that raises a red flag for me.

Where ME docs are few and far between, if you find a doctor willing to help you with symptomatic relief using pain or sleep meds, then the chances are you'll just agree and nod politely with a more daft idea. You certainly won't rock the boat by telling them it's complete bunkum.
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I've done this on a number of occasions. Getting to the Dr took all my energy. I could not engage in a larger dialogue.

Some Dr's can be so gullible.
 
Hutan said:
So, is there evidence that:
1. the vagus nerves of people with ME are understimulated?
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I can only speak for what I see in my family, and I have no evidence per se. So what I say next is only with respect to my family.

It seems the vagus nerve is an issue, but it seems to be "over-active". So stimulation wouldn't be a good idea. Indeed, a family member made the observation that "calming" it helps a bit, for a short time (I have no idea how that is done), e.g. with Prince Metal Angina Pectoris symptoms.
Why it is "over-active" I can only speculate. It's maybe due to some kind of "inflammation" (e.g. due to viruses from the Herpes family, like Zoster), which seems to increase with too much activity.

Edit: I sing or whistle under the shower or elsewhere at home. I did not observe any change in symptoms, only that it's a bit exhausting and the voice gets croaky.
 
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